美国一家三级医疗中心的 HIV 感染者中心力衰竭和心力衰竭不良结局。
Heart failure and adverse heart failure outcomes among persons living with HIV in a US tertiary medical center.
机构信息
Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Internal Medicine, Division of Cardiology, Bronx-Lebanon Hospital Center of Icahn School of Medicine at Mount Sinai, Bronx, NY.
Department of Internal Medicine, Division of Cardiology, Bronx-Lebanon Hospital Center of Icahn School of Medicine at Mount Sinai, Bronx, NY.
出版信息
Am Heart J. 2019 Apr;210:39-48. doi: 10.1016/j.ahj.2019.01.002. Epub 2019 Jan 11.
BACKGROUND
Persons living with HIV (PLHIV) have an increased risk of heart failure (HF). However, little is known about outcomes among PLHIV with HF. The study aim was to compare HF outcomes among PLHIV with HF versus individuals without HIV with HF.
METHODS
Our cohort included 2,308 individuals admitted with decompensated HF. We compared baseline characteristics, 30-day HF readmission, and cardiovascular (CV) and all-cause mortality. Within PLHIV, we assessed outcomes stratified between CD4 count and viral load (VL), and tested the association between traditional and HIV-specific parameters with 30-day HF readmission.
RESULTS
There were 374 (16%) PLHIV with HF. Among PLHIV, 92% were on antiretroviral therapy and 63% had a VL <200 copies/mL. Groups were similar with respect to age, sex, race/ethnicity, and CV risk factors. In follow-up, PLHIV had increased 30-day HF readmission (49% vs 32%) and CV (26% vs 13.5%) and all-cause mortality rates (38% vs 22%). Among PLHIV, cocaine use, HIV-specific parameters (CD4, VL), and coronary artery disease were predictors of 30-day HF readmission. Specifically, among PLHIV, those with detectable VL had higher 30-day HF readmission and CV mortality, whereas PLHIV with undetectable VL had a similar 30-day HF readmission rate and CV mortality to uninfected controls with HF. Similar outcomes were observed across strata of left ventricular ejection fraction and by CD4.
CONCLUSIONS
PLHIV with a low CD4 count or detectable VL have an increased 30-day HF readmission rate as well as increased CV and all-cause mortality. In contrast, PLHIV with a higher CD4 count and undetectable VL have similar HF outcomes to uninfected controls.
背景
HIV 感染者（PLHIV）发生心力衰竭（HF）的风险增加。然而，对于 HF 合并 PLHIV 的结局知之甚少。本研究旨在比较 HF 合并 PLHIV 与无 HIV 的 HF 患者的结局。
方法
我们的队列纳入了 2308 例因失代偿性 HF 入院的患者。我们比较了基线特征、30 天 HF 再入院和心血管（CV）及全因死亡率。在 PLHIV 中，我们评估了 CD4 计数和病毒载量（VL）分层后的结局，并检测了传统参数和 HIV 特异性参数与 30 天 HF 再入院的相关性。
结果
HF 合并 PLHIV 患者 374 例（16%）。PLHIV 中，92%接受抗逆转录病毒治疗，63%VL<200 拷贝/ml。两组在年龄、性别、种族/民族和 CV 危险因素方面相似。在随访中，PLHIV 30 天 HF 再入院（49%比 32%）、CV（26%比 13.5%）和全因死亡率（38%比 22%）更高。在 PLHIV 中，可卡因使用、HIV 特异性参数（CD4、VL）和冠状动脉疾病是 30 天 HF 再入院的预测因素。具体来说，在 PLHIV 中，VL 可检测者的 30 天 HF 再入院率和 CV 死亡率更高，而 VL 不可检测者的 30 天 HF 再入院率和 CV 死亡率与 HF 合并未感染者相似。在左心室射血分数和 CD4 分层中观察到相似的结局。
结论
CD4 计数低或 VL 可检测的 PLHIV 30 天 HF 再入院率及 CV 和全因死亡率增加。相比之下，CD4 计数较高且 VL 不可检测的 PLHIV 的 HF 结局与未感染者相似。
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